Use of PROMIS® to screen for depression in children with arthritis

• Published in: Pediatric Rheumatology 2020-11, Vol.18 (1), p.1-92, Article 92
• Main Authors: Yan, Yufan, Rychlik, Karen L, Rosenman, Marc B, Miller, Michael L
• Format: Article
• Language: English
• Subjects: Analysis; Anxiety; Arthritis; Child psychopathology; Depression, Mental; Disease; Information systems; Likert scale; Medical records; Mental depression; Mental disorders; Mental health; Pain; Parenting; Patients; Pediatrics; Peer relationships; Psoriasis; Psychological aspects; Questionnaires; Rheumatoid arthritis; Rheumatology; Social aspects; Social workers; Software; Variables
• ISSN: 1546-0096; 1546-0096
• DOI: 10.1186/s12969-020-00482-1

Background Children with JIA may experience difficulty with health related quality of life (HRQOL). The Patient Reported Outcomes Measurement Information System (PROMIS) a patient related outcome (PRO) measure, covers HRQOL domains that include physical function, mental health, and social interactions. During initial use, we found PROMIS identified children with symptoms of depression, sometimes before they shared those feelings with parents or members of the clinic team. We studied the use of PROMIS for this purpose, and to determine what demographic, clinical, and other characteristics might be related to higher depressive symptom scores. Methods From March 2014 - February 2017, at each visit, all JIA patients having met ILAR classification criteria seen by M.L.M. received the PROMIS Short Form 35 v.1.0, as part of routine care. T scores were calculated from raw scores for mobility, anxiety, depressive symptoms, fatigue, peer relationships, and pain interference domains. Data extracted by optical mark recognition software were merged with electronic medical record (EMR data), extracted by Extract/Transform/Load software, including joint counts, visit age, ANA, RF, and HLA-B27 status. Mixed effects models were used to identify significant associations of independent variables with depression T scores. Results Data from 148 patients were analyzed (114 females for 435 visits, 34 males for 118 visits; 13.8 [+ or -] 2.8 years): 70 persistent oligoarthritis, 9 extended oligoarthritis, 19 ERA, 21 polyarthritis (RF-), 5 polyarthritis (RF+), 11 undifferentiated arthritis, 3 psoriatic arthritis, 10 systemic arthritis). T scores showed wide ranges within individual JIA categories, with similar mean scores for all groups. Univariate linear mixed effects models showed significant relationships to depression T scores of gender and race (males and Asian patients with lower T scores, p < .0001, p = 0.091, respectively), joint count (p = 0.002), pain interference score (p = 0.0004), and Patient and Physician Global Assessment (p = 0.004, p < .0001, respectively). No particular JIA category was associated with Depression T scores. HRQOL domains were interrelated (p < .0001), including patients reporting symptoms of depression tending also to report symptoms of anxiety. PROMIS identified 15 patients who did not otherwise report depressive symptoms, but needed referral for counseling; eight did not endorse depressive symptoms until the 2nd or 3rd visit. Only 3 patients had